Management of cystic lesions of the tail of the pancreas.

OBJECTIVE

To emphasize that although cystic pancreatic neoplasms are stated to make up only 10% of pancreatic cysts, this number may be significantly higher if patients who are misdiagnosed with pseudocysts are considered.

DESIGN

A small case series.

SETTING

A tertiary-care centre.

PATIENTS

A consecutive sample of three patients with cystic lesions of the tail of the pancreas seen between 1992 and 1994. All three were women ranging in age from 28 to 42 years. Two had been treated previously for pancreatic pseudocysts by cystenterostomy. None had a history of pancreatitis or alcohol abuse, and gallstones were not present on ultrasonography.

INTERVENTIONS

Distal pancreactectomy and splenectomy.

RESULTS

The excised specimens from the two patients treated initially elsewhere revealed mucinous cystadenoma with atypia in one and mucinous cystadenocarcinoma with invasion into stomach in the other. In the third patient, a cystic neuroendocrine tumour and two other intrapancreatic nodules of neuroendocrine tumour were found on pathological examination.

CONCLUSIONS

Pancreatic neoplasms may be misdiagnosed as pancreatic pseudocysts. In patients without a history or risk factors for pancreatitis, a cystic pancreatic mass is not necessarily a pseudocyst, and such patients should be considered for pancreatic resection.